Medicare Insurance Plans

Alice,

It could be that there is something wrong with the Massachusetts BC/BS web site or the underlying database that populates the queries. But if you go to the link I posted above and enter Zytiga and Xtandi, you will see it respond that these are Level 2 drugs in their formulary. I do understand the difference between out of pocket maximum for the medical plan being different than for the drug plan. But, assuming the drugs are covered in the plan's formulary, a patient will revert to "catastrophic" coverage after paying the $4,700 doughnut hole amount. I just don't see how a patient could be on the hook for $14,000 unless the drugs are actually not in the approved formulary (i.e., the information on the web site is incorrect). If you look at the formulary PDF file (as opposed to the online search I posted above) these are listed as "special" drugs. But the document then goes on to explain that this means they are available only through a subset of pharmacies in state, not that they fall into a separate cost category.

Jim